First reported 19 Sep 2014•Latest report 22 Oct 2025
Definition
What this concern includes
Includes failures of dedicated controls intended to prevent or restrict unsafe access to elevated roofs, including access barriers, protected fire escapes, railings, gates, locks, environmental risk assessments and remedial measures where these directly address roof-access risk.
Not included
Excludes general roof maintenance, structural defects or building-survey failures where unsafe access to the roof is not the material concern.
Excludes ordinary access to roofs intended for authorised maintenance or emergency use when the access arrangement is appropriately controlled.
Excludes bridge, railway-track, balcony, tower, car-park and other elevated-location hazards unless the assertion specifically concerns access to an elevated roof.
Excludes general fall-prevention or premises-security deficiencies that are not directly linked to preventing unsafe access to an elevated roof.
Reports
2
Distinct published reports
Individual concerns
3
A report can raise multiple concerns
Date range
2014–2025
First to latest report issue date
Stated actions
5
Described in published responses
Reports over time
Reports over time
Reports about this concern issued each year.
* 2026 is projected from reports observed to 7 Sep 2026.
Most frequent recipients
Most frequent recipients
Reports about this concern sent to each recipient.
Birmingham and Solihull Integrated Care System1
Care Quality Commission1
Network Rail1
NHS England1
Recipient name withheld1
Executive non-departmental public body1
Health and social care service regulator1
Health-system partnership1
Rail infrastructure manager1
Type not available1
Concerns and responses across reports
Only concerns grouped under this recurring concern are included. Select any concern, action or position to view the source wording.
Birmingham and Solihull
Concerns raised2
Unprotected fire escapes providing easy access to roofs in rehabilitation settings
Lack of environmental risk assessment of fire escape and roof accessibility
This report raised 2 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.5
Action
Publish national best-practice guidance promoting person-centred safety assessment, formulation, management and environmental safety planning.
Stated by NHS EnglandStated completedThe respondent said that this action was complete when they made their response on 23 October 2025.
Action
Liaise with Birmingham and Solihull Mental Health Foundation Trust about environmental risk assessment and unauthorised roof access from the fire escape.
Stated by NHS EnglandStated completedThe respondent said that this action was complete when they made their response on 23 October 2025.
Action
Scope revisions to HTM 05-02 fire-safety guidance for healthcare-premises design.
Stated by NHS EnglandStated in progressThe respondent said that this action was in progress when they made their response on 23 October 2025.
Action
Escalate and monitor the development of national guidance on fire-escape protections in rehabilitation settings.
Stated by NHS Birmingham and Solihull Integrated Care Board and NHS Black Country Integrated Care BoardStated plannedThe respondent said that this action was planned when they made their response on 23 October 2025.
Action
Request environmental risk assessments and observe ward environments during inspections to assess premises safety.
Stated by Care Quality CommissionStated plannedThe respondent said that this action was planned when they made their response on 23 October 2025.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.4
Position
Existing guidance and provider risk-assessment arrangements are considered appropriate to manage fire-escape and roof-access risks.
Stated by NHS EnglandExisting arrangements considered sufficientThe respondent said that existing arrangements were sufficient, so no further action was needed.
Position
Specific environmental risk assessments are not required; providers must instead take reasonable steps to manage health and safety risks.
Stated by Care Quality CommissionDisputes the concernThe respondent disagreed with part of the concern or the basis for it.
Position
The Birmingham and Solihull Integrated Care Service is responsible for addressing the local fire-escape risk assessment in greater detail.
Stated by NHS EnglandRedirects responsibilityThe respondent said that another organisation was responsible for deciding or taking action.
Position
Further comment on the specific local risk assessment cannot be provided.
Stated by NHS EnglandUnable to actThe respondent said that a constraint prevented them from taking the relevant action.
Inner South London
Concerns raised1
Failure to block access to commercial-unit roofs under the railway arches
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
No linked response statements
No respondent-stated action or position is linked to these concerns in the published data.
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Includes failures of dedicated controls intended to prevent or restrict unsafe access to elevated roofs, including access barriers, protected fire escapes, railings, gates, locks, environmental risk assessments and remedial measures where these directly address roof-access risk.
